Accident and Health

Which of the following are NOT managed care organizations:

MIB

Which of the following is considered to be the time period after a health policy is issued, during which no benefits are provided for illness:

probationary period

Which of the following involves analyzing a case before admission to determine what type of treatment is necessary:

prospective review

Which of the following statements describes what an accident and health policyowner may not do:

adjust the premium payments

According to the Affordable Care Act: a dependent child's eligibility status is determined by:

age

Which of the following is NOT required to be disclosed to an applicant for health insurance:

any contingent compensation received

Who is not required to sign a health insurance application:

beneficiary

T is receiving 3000/month from a disability income policy in which T's employer had paid the premiums. How are the 3000 benefit payments taxable:

benefits are taxable to T

Which type of policy would pay an employees salary if the employer was injured in a bicycle accident and out of work for six weeks:

business overhead expense

In colorado, what is required to be covered in individual and group medical expense policies:

diabetes

M becomes disabled and is unable to work for ic months. M dies soon after from complications arising from this disability. M has a disability income policy that pays 2000 a month. Which of the following statements best describes what is owed to her estate:

earned but unpaid benefits

An insurer can deny a claim under a long-term care insurance policy for any material misrepresentation made by the insured if it has been in effect for:

fewer than 6 months

The reason for a business having a Business Overhead Expense Disability Plan is to cover:

fixed business expenses

M completes an application for health insurance but does not pay the initial premium, All of these actions must occur before M's policy goes into effect, expect:

free-look period has expired

Which of the following will a long term care plan typically provide benefits for:

home health care

All accident and health policies issued in Colorado that provide major medical services must offer policyholders the opportunity tov purchase:

home health care coverage

A life insurance policy would be considered a wagering contract without:

insurable interest

What kind of accident death and dismemberment insurance beneficiary requires his/her consent when a change of beneficiary is made:

irrevocable beneficiary

Which of the following actions will an insurance company most likely not take if an applicant, who has diabetes, applies for a disability income policy:

issue the policy with an altered time of payment of claims provision

Under a guaranteed renewable health insurance policy the insurer:

may cancel for nonpayment only

The primary difference between the Colorado Partnership LTC policy and other LTC policies is:

medicaid asset protection

A verbal or written statement which misleads a policy's features, benefits, or coverage is considered:

misrepresentation

Which of the following best describes how a preferred provider organization is less restrictive than a health maintenance organization:

more physicians to choose from

Which of these statements concerning an individual disability income policy is true:

normally includes an elimination period

Generally, how long is a benefit period for a major medical expense plan:

one year

A major Medical policy typically:

provides benefits for reasonable and necessary medical expenses, subject to policy limits

When an insured has the same disability within a specified time period and the insurance company provides the same benefits without a new waiting period, the second disability is covered under which of the following benefits:

recurrent disability

Which type of policy pays benefits to a policy holder covered under a hospital expense policy:

reimbursement

N is covered under an individual Disability policy with a 30-day elimination period and a monthly benefit of 500. N is totally disabled for 31/2 months N's total benefit received on this claim is:

1250

AN insured must notify an insurer of a medical claim within:

20 days after an accident

Insureers may request a hearing within:

20 days if their policy is rejected

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet:

Consideration clause

Essential Benefits without annual and lifetime limits are required on any health policy purchased:

through the federal marketplace

A disability elimination period is best described as a:

time deductible

R becomes disabled and owns an individual disability income policy. When is R eligible to receive disability benefits:

upon satisfying the elimination period requirement

Which of these arrangements allows one to bypass insurable interest laws:

Investor-Originated Life Insurance

How long must a replicating insurer maintain the records of a replacement transaction

5 years

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provisions specifies that coverage may be restored in this situation:

Reinstatement

M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company's underwriting department requests M's medical records and determines that M has had asthma's for many years. All of the following are probably underwriting outcomes, EXCEPT:

changing the policy's provisions.

P is a major medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim:

claim will be denied

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called an:

closed panel

Which of the following organization would make reimbursement payments directly to the insured individual for covered medical expenditures:

commercial insurer

Which of the following would be a likely candidate for disability income insurance on a key employee:

company executive

A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will:

continue coverage but exclude the heart condition.

If a producer completes an insurance application, collects the initial premium, and issues the appropriate receipt:

coverage will be contingent upon the insurer's underwriting policies